The Hardest Part
The Hardest Part is the eighteenth episode of the fourth season and the 72nd overall episode of Private Practice. Short Summary When Pete's brother, Adam, brings their sick mother for a consult, Pete discovers her illness may be his brother's fault. Meanwhile, in the wake of her book's success, Violets walks in on Sheldon just as he's about to take her archenemy on a date, and Cooper treats a young musical prodigy whose brain tumor could prevent him from ever playing the piano again. Full Summary Episode in detail. Cast PP4x18PeteWilder.png|Pete Wilder PP4x18CooperFreedman.png|Cooper Freedman PP4x18CharlotteKing.png|Charlotte King PP4x18SheldonWallace.png|Sheldon Wallace PP4x18AmeliaShepherd.png|Amelia Shepherd PP4x18SamBennett.png|Sam Bennett PP4x18VioletTurner.png|Violet Turner PP4x18FrancesWilder.png|Frances Wilder PP4x18MarlaThomkins.png|Marla Thomkins PP4x18MrHoffman.png|Dennis Hoffman PP4x18AdamWilder.png|Adam Wilder PP4x18Casey.png|Casey PP4x18Lisa.png|Lisa PP4x18PatrickHoffman.png|Patrick Hoffman PP4x18Terri.png|Terri PP4x18Pam.png|Pam PP4x18Ricky.png|Ricky PP4x18Jamie.png|Jamie PP4x18Paramedic.png|Paramedic Rodriguez Main Cast *Kate Walsh as Dr. Addison Montgomery (credit only) *Tim Daly as Dr. Pete Wilder *Audra McDonald as Dr. Naomi Bennett (credit only) *Paul Adelstein as Dr. Cooper Freedman *KaDee Strickland as Dr. Charlotte King *Brian Benben as Dr. Sheldon Wallace *Caterina Scorsone as Dr. Amelia Shepherd *Taye Diggs as Dr. Sam Bennett *Amy Brenneman as Dr. Violet Turner Guest Stars *Louise Fletcher as Frances Wilder *Alex Kingston as Marla Thomkins *Tom Bower as Dennis Hoffman *Kyle Secor as Adam Wilder *Vanessa Marano as Casey *Laura Slade Wiggins as Lisa *Michael Grant as Patrick Hoffman Co-Starring *Lizabeth Allen as Terri *Anne Marie Howard as Pam *Timi Prulhiere as Ricky *Allie Trimm as Jamie *Evan Olman as Paramedic Medical Notes Frances Wilder *'Diagnosis:' **Arrhythmia **AV dissociation **Third-degree heart block **Congestive heart failure **Digoxin overdose *'Doctors:' **Sam Bennett (cardiothoracic surgeon) **Pete Wilder (critical care medicine) *'Treatment:' **Atropine **Temporary pacemaker **Drug reversal Frances was brought into the ER with an arrhythmia. They stabilized her in the ER and Sam put in a temporary pacemaker. She'd developed congestive heart failure in prison and because the doctors there couldn't handle it, they released her. Her son, Adam, admitted that he had bribed a guard to give her digoxin, which made her worse so that she could be released. Sam later reviewed more scans and said that she was going to die and it wouldn't be much longer. Adam and Pete both sat with her while she died. Ricky, Pam, and Terri *'Diagnosis:' *'Doctors:' **Sheldon Wallace (psychiatrist) **Violet Turner (psychiatrist) *'Treatment:' **Talk therapy Ricky, Pam, and Terri came to talk to Sheldon and Violet because their daughters made a pact to become pregnant together in high school. Casey, Jamie, and Lisa *'Diagnosis:' **Pregnancy *'Doctors:' **Sheldon Wallace (psychiatrist) **Violet Turner (psychiatrist) *'Treatment:' **Talk therapy Casey, Jamie, and Lisa came in because they had all made a pact to become pregnant together in high school. Violet and Sheldon took Casey and Lisa on a tour of the maternity ward. While they were there, Casey went into labor. After seeing what happened to Casey, Jamie decided to give her baby up for adoption. Lisa came to Violet and said that her mom didn't deserve having another kid dropped on her when she was already raising three on her own. She said she wasn't sure if she wanted to keep the baby or not, but she wasn't sure how to talk to her mom about it. Violet said they could talk to her together. Patrick Hoffman *'Diagnosis:' **Pilocytic astrocytoma **Brain hemorrhage **Hematoma *'Doctors:' **Cooper Freedman (pediatrician) *'Treatment:' **Awake craniotomy Patrick, 14, came to see Cooper for numbness. When he held out his hands, one of them drooped, so Cooper ordered an MRI. Amelia reviewed the MRI and diagnosed a pilocytic astrocytoma. She recommended surgery to remove the tumor. The safest way to do it had a high potential to paralyze his hand. Because he's a pianist, he asked about other solutions. She said she could do an awake craniotomy, but it was much riskier and could paralyze his leg. He wanted to do it despite the risks because he said he can't live without playing piano. His grandfather instead decided on the safer option. Patrick said he wanted the riskier one because he felt like his grandfather only loved him because of the music. Amelia spoke to his grandfather, who said that he does love him, but said to let Patrick have the surgery he wanted. They had Patrick play while Amelia operated, so she'd know where it was safe to cut and where it wasn't. During the surgery, Patrick's grandfather was brought into the OR by Cooper, where he told his grandson he loves him. He started bleeding, so Amelia had to repair the damage. She said they wouldn't know if he'd walk again until after the swelling went down, but she got the whole tumor and he would be able to play. Casey *'Diagnosis:' **Pregnancy **Placental abruption *'Doctors:' **OB/GYN *'Treatment:' **C-section delivery Casey had a placental abruption while touring the maternity ward and had to have an emergency c-section. After delivery, Casey decided to name her baby Ben. Music "Whole New Way" - Scissor Sisters "This Time Tomorrow" - Trent Dabbs "Bring On the Wonder" - Sarah McLachlan Notes and Trivia *This episode scored 7.35 million viewers. *This is the second out of two episodes in the entire series that don't feature Kate Walsh as Addison Forbes Montgomery. *Sam says to Pete that Addison is in Seattle, delivering a baby. This baby is Sofia Robbin Sloan Torres, whom Addison had to deliver early because her mothers, Callie Torres and Arizona Robbins, were in a car accident while Callie was pregnant. *This episode runs parallel to the Grey's Anatomy episode Song Beneath the Song, as proven by Addison being absent in this episode to deliver a baby in Seattle and the air dates of both episodes (March 31, 2011). *This is the first episode to be directed by Paul Adelstein, who portrays Cooper. *This episode shows that Cooper can play the piano. 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